Gastrointestinal (GI) Sciences, Faculty of Biology, Medicine and Health, Division of Diabetes, Endocrinology and Gastroenterology, School of Medical Sciences, University of Manchester, Salford Royal Hospital (part of the Manchester Academic Health Sciences Center (MAHSC)), Salford, UK.
Dysphagia. 2023 Apr;38(2):497-509. doi: 10.1007/s00455-021-10271-x. Epub 2021 Mar 6.
Swallowing is a complex activity requiring a sophisticated system of neurological control from neurones within the brainstem, cerebral cortices and cerebellum. The cerebellum is a critical part of the brain responsible for the modulation of movements. It receives input from motor cortical and sensory areas and fine tunes these inputs to produce coordinated motor outputs. With respect to swallowing, numerous functional imaging studies have demonstrated increased activity in the cerebellum during the task of swallowing and damage to the cerebellum following differing pathological processes is associated with dysphagia. Single pulses of transcranial magnetic stimulation (TMS) have been applied to the cerebellum and have been shown to evoke motor responses in the pharynx. Moreover, repetitive TMS (rTMS) over the cerebellum can modulate cerebral motor (pharyngeal) cortical activity. Neurostimulation has allowed a better understanding of the connections that exist between the cerebellum and cerebral swallowing motor areas in health and provides a potential treatment for neurogenic dysphagia in illness. In this review we will examine what is currently known about the role of the cerebellum in the control of swallowing, explore new findings from neurostimulatory and imaging studies and provide an overview of the future clinical applications of cerebellar stimulation for treating dysphagia.
吞咽是一项复杂的活动，需要来自脑干、大脑皮层和小脑的神经元的复杂神经系统控制。小脑是大脑中负责调节运动的关键部分。它接收来自运动皮质和感觉区域的输入，并对这些输入进行微调，以产生协调的运动输出。在吞咽方面，许多功能成像研究表明，在吞咽任务期间小脑活动增加，并且在不同的病理过程之后小脑损伤与吞咽困难有关。小脑的单次经颅磁刺激 (TMS) 已被应用于小脑，并已证明可以在咽部引起运动反应。此外，小脑的重复 TMS (rTMS) 可以调节大脑运动（咽部）皮质活动。神经刺激使我们更好地了解了小脑与健康时的大脑吞咽运动区域之间的联系，并为疾病中的神经源性吞咽困难提供了一种潜在的治疗方法。在这篇综述中，我们将探讨小脑在吞咽控制中的作用的现有知识，探索神经刺激和成像研究的新发现，并概述小脑刺激治疗吞咽困难的未来临床应用。
